Common Ear, Nose & Throat Problems The information provided in this presentation is not intended to guide treatment or aid in making a diagnosis. Always consult a physician or nurse practitioner. Copyright 2002, 2014, Kevin T. Kavanagh All Rights Reserved www.entusa.com
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Common Ear, Nose & Throat Problems Ear, Nose & Throat Problems The information provided in this presentation is not intended to guide treatment or aid in making a diagnosis. Always
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Common Ear, Nose & Throat ProblemsThe information provided in this presentation is not intended to guide treatment or aid
in making a diagnosis. Always consult a physician or nurse practitioner.
Copyright 2002, 2014, Kevin T. Kavanagh All Rights Reserved www.entusa.com
This video shows the function of a larynx with a paralyzed left true vocal cord. The patient has lung cancer. She has a poorly compensated breathy voice which is difficult to understand. This patient had a 55 pack year history of smoking.
Go to http://www.entusa.com/vocal_cord_paralysis_2.htm to View Video
Copyright 2002, 2014, Kevin T. Kavanagh All Rights Reserved www.entusa.com
This video shows the function of a larynx with a large T1b Cancer on both true vocal cords and anterior commissure in 72 yr old male with a 150 pack year history of smoking. The patient quit smoking 8 years ago.
Go to http://www.entusa.com/lxca-0807.htm to View Video
Copyright 2002, 2014, Kevin T. Kavanagh All Rights Reserved www.entusa.com
Almost all cancers of the larynx are associated with smoking -- 65 of 68 larynx cancers in my practice
64 patients had a 20 pk/yr history or greater. Quitting smoking does not eliminate the patient's risk of
getting a cancer but it does prevent the risk increasing. Fourteen patients with larynx cancer had quite smoking, four patients more than 25 years ago.
Smoking causes permanent genetic damage to the epithelium.
Copyright 2002, 2014, Kevin T. Kavanagh All Rights Reserved www.entusa.com
Learn More About Larynx Cancer: http://www.entusa.com/voice_box_cancer.htm
Smoking Tobacco use remains the leading preventable cause of death in the United
States, causing more than 400,000 deaths each year and resulting in an annual cost of more than $50 billion in direct medical costs.
Each year, smoking kills more people than AIDS, alcohol, drug abuse, car crashes, murders, suicides, and fires---combined!
Approximately 80% of adult smokers started smoking before the age of 18. Every day, nearly 3,000 young people under the age of 18 become regular smokers.
Smokers pay twice as much for life insurance and will die an average of over 12 years sooner than non-smokers. Smokers have more than one chance in 10 of developing lung cancer.
Copyright 2002, 2014, Kevin T. Kavanagh All Rights Reserved www.entusa.com
Learn More About Smoking and Cancer At: http://www.entusa.com/cancer_smoking.htm
GE Reflux - OTC treatment Elevate head of bed by 6 to 8 inches. (Place blocks under bed posts.) Do not eat 4 hours before sleeping. Take Prilosec (generic omeprazole) at bedtime-- over the counter anti-
reflux medications. Avoid the following Foods: Fried/Fatty, Caffeine (Coffee, Tea,
"I am just as deaf as I am blind. The problems of deafness are deeper and more complex, if not more important, than those of blindness. Deafness is a much worse misfortune. For it means the loss of the most vital stimulus-the sound of the voice that brings language, sets thoughts astir and keeps us in the intellectual company of man." Helen Keller in Scotland A Personal Record Written By Herself. Methuen & Co. Ltd. 36 Essex Street W.C. London Page 68.
Copyright 2002, 2014, Kevin T. Kavanagh All Rights Reserved www.entusa.com
Learn More About Hearing Loss In Children: http://www.entusa.com/hearing_loss_in_children.htm
3-6 months Child should respond to your voice or speech. Does he react to your voice when he cannot see you?
7-10 months Should react when he hears, but cannot see, the dog barking, telephone ringing, footsteps, someone's voice, refrigerator opening, microwave ringing, etc.
11-15 months Can he point to or find familiar objects or people, when he is asked to? Does he respond to different sounds differently? Does he enjoy listening to music and other sounds and try to imitate them.
Most children by 12 months of age are starting to say single words.
Copyright 2002, 2014, Kevin T. Kavanagh All Rights Reserved www.entusa.com
Source--dBA SPL Heavy Traffic 80 dB Automobile (at 20 meters) 70 dB Vacuum Cleaner 65 dB Conversational Speech (at 1 meter) 60 dB Quiet Business Office 50 dB Residential Area at Night 40 dB Whisper, Rustle of Leaves 20 dB Rustle of Leaves 10 dB Threshold of Audibility 0 dB
Copyright 2002, 2014, Kevin T. Kavanagh All Rights Reserved www.entusa.com
Types of Hearing Loss- Loud NoiseSource--Dangerous Level dBA SPL Produces Pain 140-150 dB Jet Aircraft During Takeoff (at 20 meters)130 dB Discomfort Level 120 dB
SnowmobileTractor Without Cab
Rock Concert 110 dB 100-105 dB
Die Forging HammerGas Weed TrimmerChain SawPneumatic Drill
Home Lawn Mowers 95 to 100 dB Semi-trailers (at 20 meters) 90 dB
Copyright 2002, 2014, Kevin T. Kavanagh All Rights Reserved www.entusa.com
This is an acute bacterial infection usually caused by pseudomonas. The outer ear canal is swollen shut, and the auricle is very painful to touch. Treatment is to open the ear canal, place a wick, and treat with ear drops. The wick is cloth or foam rubber which will allow the ear drops to penetrate the swollen canal. Unfortunately, most oral antibiotics are ineffective. The fluoroquinolones have some effect, but they are not approved in children.
Copyright 2002, 2014, Kevin T. Kavanagh All Rights Reserved www.entusa.com
Pictures of Disease of the External Ear Canal: http://www.entusa.com/external_ear_canal.htm
Foreign bodies in the ears are common. In this child a fly died in the ear canal and laid maggots. The child visited three doctors over a one week period before being referred to an ENT.
Go to http://www.entusa.com/glomus_video.htm to View Video
Copyright 2002, 2014, Kevin T. Kavanagh All Rights Reserved www.entusa.com
When a retraction becomes fixed deep in the middle ear, skin starts to build up and infection occurs. Pus and granulation tissue are common.View Cholesteatoma Slideshow: http://www.entusa.com/JS-Slide-Shows-ENTUSA/Cholesteatoma-1/Cholesteatoma-1.htm
Treatment is surgical with a tympanomastoidectomy.Learn More About Mastoidectomy: http://www.entusa.com/mastoid_surgery.htm
Copyright 2002, 2014, Kevin T. Kavanagh All Rights Reserved www.entusa.com
A T-Tube is a myringotomy tube which stays in longer. However, there is a higher incidence of eardrum perforation once the tube comes out and the tube clogs more easily.
Copyright 2002, 2014, Kevin T. Kavanagh All Rights Reserved www.entusa.com
Perforation of eardrum Eardrum heals over tube Otitis media – 33% are pseudomonas Tube intrudes completely into the middle ear Cholesteatoma Monolayer – not clinical significant Bleeding – usually minor from a tube granuloma
Copyright 2002, 2014, Kevin T. Kavanagh All Rights Reserved www.entusa.com
Learn More About Myringtomy Tubes: http://www.entusa.com/ear_tubes.htm
Bacterial Resistance is a big problem--Antibiotics with a long half life which are present for days in subtherapeutic levels foster bacterial resistance.
Copyright 2002, 2014, Kevin T. Kavanagh All Rights Reserved www.entusa.com
Learn More About Ear Infections: http://www.entusa.com/ear_infections.htm
View Slideshow on Acute Otitis Media:http://www.entusa.com/JS-Slide-Shows-ENTUSA/Acute-Otitis-Media/Acute-Otits-Media.htm
Types of Bacteria Streptococcus Pneumonia, Haemophilus Influenzae (this is not the flu virus), Moraxella catarrhalis. Less commonly, Mycoplasma Pneumoniae,
Streptococcus Pyogenes, Staphylococcus Aureus along with other bacteria and viruses.
Copyright 2002, 2014, Kevin T. Kavanagh All Rights Reserved www.entusa.com
Learn More About Ear Infections: http://www.entusa.com/ear_infections.htm
View Slideshow on Acute Otitis Media:http://www.entusa.com/JS-Slide-Shows-ENTUSA/Acute-Otitis-Media/Acute-Otits-Media.htm
Adapted from Krasemann et al. Clin Infect Dis. 2001;32:S51.
Reimer and Carroll. Clin Infect Dis. 1998;26:742-748. Marrie. Infect Dis Clin North Am. 1998;12:723-740.Bartlett et al. Clin Infect Dis. 1998;26:811-838.
(Percent of Pathogens)
Strep. Pneumonia Resistance
A single plasmid can carry the genes for resistance to both the penicillin and macrolide antibiotics.
The mechanism of penicillin resistance in this organism is by producing a penicillin binding protein and not by producing penicillinase (an enzyme which breaks down penicillin).
Copyright 2002, 2014, Kevin T. Kavanagh All Rights Reserved
Nonsusceptibility to Penicillin and β-Lactamase Production
by H. influenzae, S. pneumoniae
0%
10%
20%
30%
40%
50%
1970 1975 1980 1985 1990 1995 1997 1998Year
% o
f Tot
al
S. pneumoniae
H. influenzae
Thornsberry C. Infect Med. 1993;93 (suppl):15-24. Barry AL. Antimicrob Agents Chemother. 1994;38:2419-25. Washington JA. Diagnostic Microbiol Infect Dis. 1996;25:183-190. Thornsberry C. Diagnostic Microbiol Infect Dis. 1997;29:249-57; Doern GV. Antimicrob Agents Chemother. 1996;40:1208-13. Thornsberry C. J Antimicrob Chemother. 1999;44:749-59. Data on File. RESP.
Geslin P. Clin Infect Dis. 1992;15:95-98. * 1999 RESP data, BMS data on file.
Prevalence Over Time
Antibiotic Treatment – Acute Otitis Media
No Risk Factors Amoxicillin 40 – 90 mg/kg/day If penicillin allergic TMP – SMX or
Erythromycin-Sulfisoxazole or Macrolides
If Treated Within Prior Month Amoxicillin, Sulfa or Macrolides are
NOT RECOMMENDED
Controversies in the Medical Management of Persistent and Recurrent Acute Otitis Media Recommendations of a Clinical Advisory Committee Pichichero, ME, et.al Ann Oto Rhinol Laryngo: 109:2-12,2000
Streptococcus Pneumonia – Acute Otitis Media
Most Likely to be Strep Pneumonia: Increase otalgia and fever Spontaneous perforation
Risk Factors for Strep Pneumonia Resistance: Daycare Younger than 2 years of age Contact with an individual treated with antibiotics History of recurrent acute otitis media
Controversies in the Medical Management of Persistent and Recurrent Acute Otitis Media Recommendations of a Clinical Advisory Committee Pichichero, ME, et.al Ann Oto Rhinol Laryngo: 109:2-12,2000
Streptococcus Pneumonia – Acute Otitis Media
Mechanism of antibiotic resistance is a penicillin binding protein and NOT by producing penicillinase. Thus, penicillinase inhibitors will NOT be effective
A single plasmid can carry the genes for resistance to both the penicillin and macrolide antibiotics.
Recommendations to increase the Ampicillindosage to 90 mg/kg/day
Controversies in the Medical Management of Persistent and Recurrent Acute Otitis Media Recommendations of a Clinical Advisory Committee Pichichero, ME, et.al Ann Oto Rhinol Laryngo: 109:2-12,2000
Haemophilus influenzae – Acute Otitis Media
Risk Factors for Haemophilus influenzae Resistance
Preceding therapy with amoxicillin. Most Likely to be Haemophilus influenzae Otitis-conjunctivitis Syndrome
Controversies in the Medical Management of Persistent and Recurrent Acute Otitis Media Recommendations of a Clinical Advisory Committee Pichichero, ME, et.al Ann Oto Rhinol Laryngo: 109:2-12,2000
Haemophilus influenzae – Acute Otitis Media
Mechanism of resistance is through the production of penicillinase.
Treatment is with a penicillinase inhibitor, cefuroxime, or cefdinir.
Controversies in the Medical Management of Persistent and Recurrent Acute Otitis Media Recommendations of a Clinical Advisory Committee Pichichero, ME, et.al Ann Oto Rhinol Laryngo: 109:2-12,2000
Copyright 2002, 2014, Kevin T. Kavanagh All Rights Reserved www.entusa.com
The Nonprescription Drugs Advisory Committee of the Federal Drug Authority (FDA) has issued a warning against using cold and sinus medications in young children and children under two years of age. Specifically:
Do not give cough medicine to children under 2 years of age.
Too much medicine may cause serious life threatening side effects.
Over dosage can occur if two medicines have the same type of ingredients.
Cold and cough medicines only treat the symptoms of the common cold they do not cure the cold. The child will get better with time.
For more information go to: http://www.fda.gov/cder/drug/advisory/cough_cold.htm
FDA reaffirmed the above statements plus stated cold and sinus medications containing one or more of the following ingredients: decongestants, expectorants, antihistamines and antitussives. These medications were found not to be effective in children under the age of 6 years and the safety of there use in this age group had not been established. See Fox News: http://www.foxnews.com/story/0,2933,303616,00.html
Copyright 2002, 2014, Kevin T. Kavanagh All Rights Reserved www.entusa.com
Medical Management of Acute Sinusitis Recommendations of a Clinical Advisory Committee on Pediatric and Adult Sinusitis Brook, I, et.al, Ann Oto Rhinol Laryngo: 109:2-12,2000
The American Academy of Otolaryngology - Head and Neck Surgery, on September 2007, published guidelines for the treatment of rhinitis and bacterial sinusitis. Rhinosinusitis affects 31 million patients in the United States each year. The vast majority of these infections are caused by virus and antibiotics are not effective. The common cold falls into this category.
Copyright 2002, 2014, Kevin T. Kavanagh All Rights Reserved www.entusa.com
Learn More About “Colds” and Rhinitis”: http://www.entusa.com/colds_sinus.htm
Medical Management of Acute Sinusitis Recommendations of a Clinical Advisory Committee on Pediatric and Adult Sinusitis Brook, I, et.al, Ann Oto Rhinol Laryngo: 109:2-12,2000
Clinicians need to distinguish between bacterial and viral infections. A diagnosis of a bacterial infection should be suspected if:
Symptoms of acute rhinosinusitis are present for 10 or more days.
Symptoms worsen within 10 days after an initial improvement.
Copyright 2002, 2014, Kevin T. Kavanagh All Rights Reserved www.entusa.com
Second Line Cefdinir Cefuroxime axetil Amoxicillin-clavulante
Third Line Macrolides Floroquinolones Clindamycin
Medical Management of Acute Sinusitis Recommendations of a Clinical Advisory Committee on Pediatric and Adult Sinusitis Brook, I, et.al, Ann Oto Rhinol Laryngo: 109:2-12,2000
Copyright 2002, 2014, Kevin T. Kavanagh All Rights Reserved www.entusa.com
Learn More About “Colds” and Rhinitis”: http://www.entusa.com/colds_sinus.htm
30% to 60% of S pneumoniae and H influenzae strains resistant or not eradicated.
Medical Management of Acute Sinusitis Recommendations of a Clinical Advisory Committee on Pediatric and Adult Sinusitis Brook, I, et.al, Ann Oto Rhinol Laryngo: 109:2-12,2000
Copyright 2002, 2014, Kevin T. Kavanagh All Rights Reserved www.entusa.com
Prevnar - Heptavalent Pneumococcal Vaccine to S. Pneumonia
Recommended for Children Under the Age of 2. Over the age of 2, sometimes a single dose is recommended.
Decrease the incidence of ear tubes by 20% but a prevention NOT a treatment. Thus, if has recurrent otitis media on the basis of eustachian tube dysfunction, tubes will still be needed.
Copyright 2002, 2014, Kevin T. Kavanagh All Rights Reserved www.entusa.com
Most heal in 2 to 3 weeks on there own and do not require surgery. If from a water impact, use antibiotic ear drops, otherwise drops do not have to be used. If vertigo is present, refer to an ENT, surgery for an inner ear fistula may be required.
Copyright 2002, 2014, Kevin T. Kavanagh All Rights Reserved www.entusa.com
Learn More About Eardrum Repair:http://www.entusa.com/eardrum_repair.htm
View Slideshow of Eardrum Perforations:http://www.entusa.com/JS-Slide-Shows-ENTUSA/Eardrum-Perforations/Eardrum-Perforations.htm
Treat if large or symptomatic -Causing external otitis or hearing loss. Exotoses are usually multiple and can be removed with surgery. Sometimes felt to be caused by chronic exposure to cold water or alcohol.
Copyright 2002, 2014, Kevin T. Kavanagh All Rights Reserved www.entusa.com
Congenital Fixation of the Stapes. Usually found in white females in early 20’s. Treated with Surgery (Stapedectomy) or Hearing aid placement. Some evidence sodium fluoride helps
Copyright 2002, 2014, Kevin T. Kavanagh All Rights Reserved www.entusa.com
Learn More About Stapedectomy Surgery: http://www.entusa.com/stapedectomy.htm
The patient is placed on his back with his head turned to one side and hanging over the end of the table (Halpike-Maneuver). The ear which is causing the dizziness is placed downward. The PRM is then performed slowly over 2 minutes. The position of the patient's head is not changed to his body. A vibrator is used to help mobilize the particles.
Go to http://www.entusa.com/particle_repositioning_maneuver.htm to View Video
Copyright 2002, 2014, Kevin T. Kavanagh All Rights Reserved www.entusa.com
Chronic sun exposure is the most common cause, but smoking can also be an etiology. The cancer is treatable with surgery or radiation therapy. The picture shows a T2 N0 (tumor size between 2 to 4 cm, with no lymph node spread) squamous cell carcinoma of the lower lip. The patient was treated with surgical resection and reconstruction using an Abbe-Estlander Lip Flap.
View HTML Slide Show On Abbe-Estlander Flap:http://www.entusa.com/JS-Slide-Shows-ENTUSA/
This patient has a basal cell carcinoma lip cancer. It is a less aggressive tumor than squamous cell carcinoma, see above slide. Basal Cell Carcinoma spread and destroy tissue locally, but do not metastasize (spread by blood or lymphatics). Treatment is surgical excision or radiation therapy.
Copyright 2002, 2014, Kevin T. Kavanagh All Rights Reserved www.entusa.com
Penciclovir cream is a prescription medication which is approved by the FDA for treatment. Other medications, Acyclovir ointment, Valacyclovir and Famcyclovir are only approved for genital herpes but many doctors also use them to treat oral herpes (cold sores). A new over-the-counter medication approved by the FDA is Abreva. It also effective in the treatment of cold sores. It is believed to protect the skin cells from viral damage.
Copyright 2002, 2014, Kevin T. Kavanagh All Rights Reserved www.entusa.com
Shingles are caused by the Herpes Zoster Virus. They occur many years after an individual has had chicken pox. The lesions are seen on the patient's right jaw and right half of his tongue. This corresponds to the lower division of the trigeminal nerve and the lingual nerve. Treatment was with a seven day course of Valacyclovir given one gram three times a day.
Copyright 2002, 2014, Kevin T. Kavanagh All Rights Reserved www.entusa.com
Apthosis ulcers are shallow small painful ulcers which appear on mobile mucosa in the oral cavity. They are often found in individuals that are under stress. The cause of these ulcers is unknown. They can be treated by applying Amlexanox gel to the ulcers four times a day for 7 to 10 days.
Copyright 2002, 2014, Kevin T. Kavanagh All Rights Reserved www.entusa.com